Feasibility and efficacy of helical intensity-modulated radiotherapy for stage III non-small cell lung cancer in comparison with conventionally fractionated 3D-CRT

Abstract

Background:The standard treatment for stage III non-small-cell lung cancer (NSCLC) is still 60 Gy in conventional fractions combined with concurrent chemotherapy; however, the resulting local controls are disappointing. The aim of this study was to compare and assess the feasibility and efficacy of hypofractionated chemoradiotherapy using helical tomotherapy (HT) with conventional fractionation as opposed to using three-dimensional conformal radiotherapy (3D-CRT) for stage III NSCLC. Methods: Sixty-nine patients with stage III (AJCC 7th edition) NSCLC who underwent definitive radiation treatment at our institution between July 2011 and November 2013 were reviewed and analyzed retrospectively. A dose of 60 Gy in 20 fractions was delivered in the HT group (n=34), whereas 60 Gy in 30 fractions in the 3D-CRT group (n=35). Primary endpoints were toxicity, overall response rate, overall survival (OS) and progression-free survival (PFS). Results: The median follow-up period was 26.4 months. V20 (P=0.005), V30 (P=0.001), V40 (P=0.004), mean lung dose (P=0.000) and max dose of spinal cord (P=0.005) were significantly lower in the HT group than in the 3D-CRT group. There was no significant difference in the incidences of acute radiation pneumonitis (RP) ≥ grade 2 between the two groups, whereas the incidences of acute radiation esophagitis ≥ grade 2 were significantly lower in the HT group than in the 3D-CRT group (P=0.027). Two-year overall response rate was significantly higher in the HT group than in the 3D-CRT group (P=0.015). One-and 2-year OS rates were significantly higher in the HT group (95.0% and 68.7%, respectively) than in the 3D-CRT group (85.5% and 47.6%, respectively; P=0.0236). One-and 2-year PFS rates were significantly higher in the HT group (57.8% and 26.3%, respectively) than in the 3D-CRT group (32.7% and 11.4%, respectively; P=0.0351). Univariate analysis indicated that performance status (PS), T stage and radiotherapy technique were significant prognostic factors for both OS and PFS. Multivariate analysis indicated that PS and radiotherapy technique were independent prognostic factors of OS and PS was independent prognostic factor of PFS. Conclusions: Hypofractionated chemoradiotherapy via HT can shorten the radiotherapy time without increasing treatment-related toxicity. The preliminary findings are that OS and PFS can be improved by hypofractionated chemoradiotherapy via HT for patients with stage III NSCLC.

Treatment-duration is related to changes in peripheral lymphocyte counts during definitive radiotherapy for unresectable stage III NSCLC

“…Treatment planning, including radiation targets, normal tissue dose constraints, and delivery techniques for locally advanced NSCLC in our institution have been previously described [8]. The fractionation regimes primarily depended on the treating physicians’ preference, based on the clinical tumor size and location.…”

Outcomes of Image-Guided Moderately Hypofractionated Radiotherapy for Stage III Non-Small-Cell Lung Cancer

“…e institutional dosimetry constraints for normal organs at risk (lungs, heart, esophagus, and spinal cord) were previously described in detail [15]. e following RT schemes were implemented: (1) 60 Gy/20 fractions (3.0 Gy/fraction, BED � 78 Gy, commonly used for peripheral tumors); (2) 62.…”

Outcomes of Hypofractional Tomotherapy in Patients with Stage III Nonsmall Cell Lung Cancer Who Are Not Eligible for Surgery or Concurrent Chemoradiation

“…In 2013, Oh et al reported that chemotherapy concurrent with radiotherapy (2.4 Gy/f) can achieve a median survival time of 27.3 months [ 11 ]. In 2016, He et al reported a median survival time of 31.6 months with the use of tomotherapy (60 Gy/20f) in patients with stage III NSCLC; the 1-year and 2-year survival rates were 88.2% and 58.1%, respectively [ 12 ]. In a study by Walraven et al, high-dose radiotherapy (66 Gy/24f) with cisplatin was found to prolong the median survival time to 31.5 months; the 1-year and 5-year survival rates were 74.5% and 37.3%, respectively [ 13 ].…”